Compelling commentary on children's health

An ad for the popular pain reliever Motrin has created a
Twitter-style tempest among mommy and daddy microbloggers who find the ad patronizing and
disrespectful.The ad from McNeil
Consumer Healthcare and their agency (Taxi NYC) starts off by saying that while
babywearing is fashionable right now, moms who wear their babies cry more than
those who don’t. It also suggests that women wear their babies because it “makes them look
like an official mom.”If I were a
gamblin’ man I’d bet this copy was written by a room full of men after a few
beers.

The most remarkable thing to watch has been less the
reaction and more the medium by which the reaction traveled among moms and dads.It’s the Twitter effect and a clear
example of the power of microblogging (You can follow the Twitter feed here.) As important as anything else was the fact that it took close to a day
for Motrin to identify the gaffe and react.

While I expect to see this cautionary tale carried on for
days to come in the MSM, the lesson for companies such as McNeil Consumer
Healthcare is the importance of a defined and actionable social media strategy,
especially surrounding provocative ad campaigns.

The ad has been pulled but you can find bits of it here at Small Dots - look at the bottom of the post.

Over the past few weeks I’ve had several questions from
parents on a problem referred to as sleep feeding.What is it? Why do babies do it?What can I do about it?And (perhaps the most interesting
issue) where did this problem come from?Here’s my take.And I’ll
modify this over time as I learn more.

What is sleep
feeding?

Quite simply, sleep
feeding is a popular term used to describe babies who feed nearly exclusively
when asleep.Better put, these are
babies who have such a difficult time feeding when awake that their sleep state
appears to relax them to the point that they are more organized and able to
feed. Parents are consequently forced to put their baby to sleep in order to
help them maintain their intake.Mention of the problem in our current body of medical literature is
scarce, if not absent.

But while
the popular discussion of sleep feeding is new, the problem is not.I describe the phenomenon of sleep
feeding in my 2007 book, Colic Solved –
The Essential Guide to Infant Reflux and the Care of Your Crying,
Difficult-to-Soothe Baby (see page 46).And over the past 10 years I’ve evaluated and treated many
babies with sleep feeding.

Most babies I have seen with sleep feeding represent
variants where some feeding can be completed while awake but only with a great
deal of effort.

What causes sleep
feeding?

As someone who has
made a living evaluating feeding and digestive disorders in babies, I have
found that the vast majority of infants with sleep feeding in my practice
suffer with symptoms of acid reflux.Here’s what happens:

2.Painful esophageal inflammation leads to painful
feeding marked by frequent pulling from the bottle or nipple.

3.If not treated, babies continue to struggle to feed and
potentially develop an aversion to feeding.

4.Parents discover that feeding goes better when sleeping
and the pattern is facilitated in order to maintain appropriate milk intake.

Another problem that can predispose to a pattern of sleep
feeding in babies is milk protein allergy.Allergy can create inflammation just like that seen with
acid reflux.And while we always
have to consider anatomic problems in any baby with feeding issues, those with
anatomic issues in the throat or swallowing tube are unlikely to feed any
better when asleep.In other
words, the plumbing won’t change with state of arousal.

It’s important to look beyond the pattern of feeding while
asleep in order to identify what’s behind an infant’s feeding issue.In other words, the nature and pattern
of feeding while awake often offers clues to the presence of reflux esophagitis
in a baby.And the same is true
for allergic inflammation in the gut.Other signs and symptoms as detailed in my book will help identify the
baby with subtle signs of reflux or painful feeding.

In theory, any condition that interferes with smooth,
comfortable feeding could lead a parent to help a baby develop sleep
feeding.Consequently acid reflux
should not be assumed to be the primary problem.It needs to be diagnosed based on clinical criteria.

What can parents do
with a sleep feeding baby?

It’s important for parents to understand that sleep feeding appears to
be a reactive phenomenon rather than a primary problem or condition.In other words, feeding during sleep is
a pattern that develops out of necessity in a child with an issue that prevents
effective feeding while awake. What’s the primary issue?Consequently our attention needs to be
on identifying what’s going on to create such problematic feeding.This is not an issue that you can
resolve on the Internet or through the advice of others in a chat room.While support is critical, a hands-on
assessment by a trained expert is critical.

Here are a few things to keep in mind when getting help for
your baby:

·Look and
treat.Look for and treat
conditions that predispose to painful or difficult feeding.Acid reflux and allergy need to be
firmly excluded.

·Enlist an
expert.If acid reflux has
been firmly excluded, consider an assessment by a pediatric speech pathologist
or occupational therapist experienced in infant feeding.Two things are critical here:pediatric specialization and infant
feeding experience.You want to
find a therapist who spends all of their time with children and has extensive
clinical experience in infant feeding disorders.If you live in a small community, seeking the input of a
speech pathologist or OT who dabbles in children may be a waste of time.Beat a path to the nearest city with
pediatric services.If your
pediatrician isn’t immediately comfortable assessing your baby look for consultation
with a pediatric gastroenterologist.

·Simple
feeding difficulty or long standing aversion?Recognize that when a baby’s primary feeding problem is
identified and treated early, normal patterns of eating while awake can often
be resumed.The baby older than
5-6 months of age, however, may potentially have aversive behaviors that persist
long after the primary problem has been addressed.This mandates therapy by a professional experienced in
infant feeding therapy.

·Never
force feed.While tempting,
force feeding a baby with an underlying feeding issue is likely to compound the
stress, fear and anxiety already associated with the bottle or breast.

Why are parents
talking about sleep feeding?

This
is possibly the most interesting question surrounding the sleep feeding
phenomenon.Why wasn’t anyone
talking about this last year, for example.Is this some sort of new issue?A modern epidemic perhaps?Hardly.As I
mentioned, sleep feeding has been around as long as reflux has plagued
babies.The current discussion is
just one step in the sequence of recognizing the problem of reflux in babies.

It’s interesting to note that “sleep feeding” or “dream
feeding” as a concept has become popularized recently due to social networking
– Chat rooms and other forms of social media are allowing mothers with sleep
feeding babies to share their experiences and recognize that their baby’s
unusual behavior may not be that unusual.This is a clear example of how e-patients empower themselves and
actually get answers.

Should your pediatrician know about sleep feeding?

I
would have to say that as someone who takes referrals from 200-300 well-trained
pediatricians, knowledge about sleep feeding and its relationship to acid
reflux disease is not standard.Remember that acid reflux disease in infancy and childhood is still a
relatively new concept.And considering
that this phenomenon hasn’t been reported in the medical literature I wouldn’t
expect it to be in the minds of primary care physicians.Keep in mind, however, that there
remain physicians in practice who don’t believe that acid reflux disease is
much of a concern in children.This is one more reason to be informed.

Most babies suffering with sleep feeding will typically
demonstrate other signs of reflux or allergy.But bringing these issues to the forefront during a doctor’s
visit is more likely to result in intervention and appropriate treatment.

Help me to help you

If your baby is a sleep feeder I would
love to hear from you.While I
can’t offer medical advice, our discussion will help me learn about the
patterns of sleep feeding encountered by parents.Email colic1 at mac dot com.

12,000 bottles of Mylicon gas drops were pulled off shelves
today over concerns that some of the bottles could contain pieces of
metal.The recalled bottles are
from lots SMF007 and SMF008. You
can find these numbers printed on the bottom of the box and on the lower-left
side of the sticker on each bottle.

For information on how to dispose of the drops and obtain a
refund or replacement, call 800-222-9435 or visit Mylicon.

One lesson here is that no matter what we give to our
children there are always associated risks.Even reliable brands like Mylicon fall subject to human (or
mechanical) error.And we
shouldn’t be dispensing to our babies what isn’t absolutely necessary.

This raises the question:Are gas drops necessary?

As a pediatric gastroenterologist who spends most of his
waking hours contemplating gas, I can’t say that they are.Remember that most gas in babies is a
consequence of air swallowing.This
can occur during feeding from a poor latch or an inappropriately matched bottle
system.Air swallowing can also result
from crying due to the pain of gastroesophageal reflux or allergy.In these latter cases the amount of air swallowed is
significant enough not to be broken down by a few drops of simethicone.

The Corn Refiners Association, known for bringing us high
fructose corn syrup (HFCS), is on the move to buff up the image of this bastard
sweetener.Long felt to be a
contributor to our growing obesity problem, HFCS has been referenced as “the
crack of sweeteners.”You can see
one of the CRA’s YouTube videos here.Propaganda?Look at the
video, read on and make your own decision.

So what’s the scoop?Is HFCS really the evildoer that some would have us believe?Here’s what you need to know:

Processed sugar 101.HFCS is a processed sweetener made from
corn starch and it contains a high level of fructose (found in fruits and
honey) and glucose.HCFS is made
up of about 50 percent fructose and 50 percent glucose, which is about the same
composition of table sugar.While
it may be from corn, HFCS’s refined composition results in remarkably quick
absorption which can impact a child’s insulin levels quickly and
drastically.And this stuff is
everywhere, from ketchup to twinkies.Manufacturers love it because it’s 75% sweeter than sugar, it blends
well into foods and it’s cheap.

HCFS and the obesity
link.The consumption of HFCS
has increased 250% over the past 15 years which has lead some to assume that
HFCS is the core thread in our obesity problem.Further, we consume approximately 300 more calories per day
than we did in 1985.According to
data cited by Michael Pollan in his book, In
Defense of Food, about a quarter of this caloric increase comes from
HFCS.But another quarter come
from fat and about half from grains.So while corn syrup isn’t helping matters, it definitely isn’t operating
alone.Beyond it’s pervasive
presence in just about everything our children eat and it’s propensity for
quick absorption, there’s nothing specific about a HFCS calorie that puts a
child at higher risk for getting fat.

Bottom line.So while HFCS may not
represent an independent threat to our children, it’s the volume of consumption and the
context in which our children consume HFCS that represents a problem.Processed foods high in calories and
fat taken in quantity will put any child at risk for overweight.If you really want to minimize HFCS,
read your labels.But be prepared
to find it everywhere.Your best general
move is to minimize processed foods and offer whole foods whenever possible.

For a little fun check out A Life Less Sweet and follow one family's journey to eliminate HFCS from their world.

Everybody has reflux.But not everybody is sick with reflux.And so it goes for babies.Spits, urps and wet burps, the sin qua non of reflux, are
what we expect in healthy, normal babies.But are there other signs to suggest that your baby has more than a
simple case of the spits?You
bet.Here are 5 common signs of
reflux in babies that parents often witness but don’t associate with reflux:

1.Irritability.Tummy
contents are quite acidic and create painful irritation when washed over the swallowing tube and throat.Look for pain after eating and when
lying down.The irritability
associated with reflux also causes baby to arch more than crunch.

2.Congestion.If refluxed
tummy contents reach the throat it creates a slight degree of swelling and
irritation.The result is noisy,
congested breathing often mistaken for allergy or cold.Think of reflux when congestion is
persistent and associated with other signs of reflux.

3.Sleep
disturbance.When it comes to
reflux, gravity is king.And recumbency
may make it more apparent.While a
baby may not have dramatic symptoms during waking hours, the horizontal baby
may show her true colors.Look for
acute, “pin-in-the-foot” awakening, unsettled sleep.

4.Difficulty
feeding.Sometimes feeding
difficulty is the only sign that a baby is suffering with acid-related
pain.Esophagus (swallowing tube)
irritation classically makes babies pull back and fight the breast or bottle
resulting in feeding sessions painfully long for mom and baby.I’ve referred to this pattern as
indecisive or chaotic feeding.

5.Gas.Yes, gas.As it turns out, the indecisive feeding described in #4
above frequently leads to big air swallowing.And what goes down must come out.I frequently evaluate babies with debilitating gas where the
inciting problem is actually chaotic feeding from reflux.Who knew?

For more colorful details of the above symptoms, pick up a
copy of Colic Solved – The Essential
Guide to Infant Reflux and the Care of Your Screaming, Difficult-to-Soothe Baby (2007 Ballantine).

Okay.I was
pushed by a compelling argument recently launched in the Wall Street Journal for
Twitter. And after watching from a distance I've decided to take the plunge. You can follow me here. Just like when I started Parenting Solved, I'm not sure where this will lead. I am interested in how social media can influence the dissemination of health information. Let's see what happens.